Multi-beat Acquisition Research Articles

ECHO ROUND: THREE DIMENSIONAL TRIMMING, THE FREE ANGLE ALTERNATIVE FOR MITRAL AND AORTIC VALVE VITIUM ASSESSMENT.

Three-dimensional (3D) Technology provides real time dynamic assessment and allows for multiplanar reconstruction (MPR) for the different cardiac structures. However, it is much more demanding regarding the Echo device specification, and operator experience in both loop acquisition, enhancement and of course interpretation. Trimming function is one of the post-acquisition software tools, which can be used in step-by-step assessment of the Mitral valve (MV) and aortic valve (AV) vitrium. It didn't overcome the required experience required for the interpretation of 3D images. But when systematically done, it makes it more objective and allows for assessment of the coaptation line along the valve leaflets, even in cases where it is impossible to assess in 2D as between non-coronary and left coronary AV cusps. The loops in this poster were acquired with the Philips Affinity 70 and the X7-2T transoesophageal matrix array transducer. The basic requirement of the 3D loop acquisition is guided by the published recommendation as it is and when possible multibeat acquisition is used.1. In MV Our examination started in Midesophageal Intercommisural View with 3D Zoom function. We rotated the acquired loop to obtain the surgical view of the MV with the Aorta at 12 O'clock (Figure 1, Step 1). At this point we rotated the aorta to be positioned at 9 O'clock. (Figure 1 Step 2). Then, using the track ball, we rotated the 3D picture 90 degrees in the vertical axis to be facing the lateral annulus of the MV (Figure 1, Step 3) . Starting from this view, using the face Trimming function (figure 1 Step 4) we have adjusted the trimming level going deeper all through the MV from lateral to medial, examining the coaptation line all through all parts of the leaflets. What also helped to delineate the leaflets was to add more gain (in controversy to what is normally done to improve the 3D Image). For orientation, we recommend rotating the 3D loop back to surgical view to localize the trimming level. Color Flow Examination normally requires a multibeat acquisition to get a reasonable frame rate. We also trimmed from lateral to medial till we could see the Regurgitation Jet. (Figure 3) For AV we started with the Midesophageral AV short axis view and using loop was acquired using the 3D zoom function (Figure 4). Using the same technique we have adjusted the trimming line to go through the coaptation line needed to be examined between Non coronary cusp (NCC) – Right coronary cusp (RCC), RCC- Left coronary cusp (LCC) and NCC-LCC . (figure 5) .In each level we used the track ball to rotate the 3D image to get an inface view where we could see the coaptation. We could also measure coaptation height, coaptation length and identify single leaflet pathology. <b>Conclusion:</b> In contrast to 2D images the Trimming function allows a free angle generation of 2D images for angles difficult or sometimes impossible to be obtained with normal 2D cutting or even biplane.

Left atrial function assessed by 3-dimensional echocardiography is an independent predictor for mortality in heart failure with reduced ejection fraction

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant TE 137/2020 Background. Patients with heart failure and reduced ejection fraction (HFrEF) are at high risk for death. So far, left ventricular ejection fraction (LVEF) measured by 2-dimensional echocardiography (2DE) has been considered the main predictor of mortality in HFrEF. However, there are new echo parameters reflecting cardiac remodeling, assessed by 3-dimensional echocardiography (3DE), that might improve risk stratification in HFrEF. Aim. To assess comparative prognostic value of left heart function and remodeling parameters, measured by 2DE versus 3DE, in patients with HFrEF. Methods. 142 consecutive patients (60 ± 17 years, 91 males), diagnosed with HFrEF, in sinus rhythm, were assessed by 2DE, using dedicated views for the LV and left atrium (LA), and by 3DE, with full-volume multi-beat acquisitions of the LV and LA. Left ventricular volumes (LVVs) were measured from 2DE views, using the modified Simpson biplane method, and from 3DE using dedicated software. Maximal and minimal indexed LAVs were measured from 2DE, using the biplane area-length formula (2D_LAVmax and 2D_LAVmin); and from 3DE, using dedicated software package (3D_LAVmax and 3D_LAVmin). Patients were followed for 5 years (57 ± 11 months) after the index event. Primary outcome was mortality. Secondary outcomes were a composite endpoint (CE) of death and hospitalization for heart failure (HHF); HHF; and a composite cardiac events end-point (MACE) of death, HHF, myocardial infarction, coronary revascularization, arrhythmias, or cardiac resynchronization therapy. Results. At 5 years we recorded 52 deaths, 70 CE, 36 HHF, and 73 MACE. At baseline, mean 2DE and 3DE LVEFs were 32 ± 10% and 32 ± 9%, respectively. There was no significant difference between the LVVs or LVEF by 2DE or 3DE between survivors and non-survivors. However, there was a significant difference for total and indexed 2D_LAVmax, 3D_LAVmax, and 3D_LAVmin (Table 1) between survivors and non-survivors. Similarly, there was no significant correlations with endpoints for the 2DE or 3DE LVVs. However, total and indexed 2D_LAVmax correlated with death, CE, HFH, and MACE, all with P &amp;lt; 0.03. Furthermore, total and indexed 3D_LAVmax, and 3D_LAVmin correlated with death, CE, HFH, and MACE, all with P &amp;lt; 0.05. In a linear multivariate regression model, that included 2DE and 3DE LVEF, indexed 2D and 3D LAV max and min, only indexed 3D_LAVmin was an independent predictor for death (p &amp;lt; 0.001), CE (p = 0.005), HFH (p = 0.009) and MACE (p = 0.006). Furthermore, by ROC analysis, an indexed LAV of 30 ml/m2 by 3DE was able to predict death ( Sb 94%, Sp 80%, AUC 0.70), CE (Sb 98%, Sp 80%, AUC 0.67), HFH (Sb 96%, Sp 80%, 0.67), and MACE (Sb 93%, Sp 76%, AUC 0.66). Conclusion. LVEF by 2DE and 3DE, while smaller in non-survivors, was unable to predict death in a small cohort of patients with HFrEF. However, LAVs, particularly by 3DE, were able to predict cardiac events, suggesting the potential key value of evolving cardiac substrate. Abstract Table 1

Normal ranges of left atrial volumes and ejection fraction by 3D echocardiography in adults: a systematic review and meta-analysis.

Increased sizes and dysfunction of the left atrium have been related to adverse outcomes. 3D-echocardiography is more accurate than 2D-echocardiography in estimating LA volumes and ejection fraction. However, the use of 3DE for LA analysis is limited by the absence of established reference values. We performed a systematic review and meta-analysis to provide reference ranges of LA maximum and minimum volumes indexed for body surface area (LAVi max and LAVi min, respectively), and LA-EF assessed by 3DE in healthy adults. Data search was conducted from inception through September 15, 2021, using the following Medical Subject Heading terms: left atrial/atrium, three-dimensional/3D echocardiography. The study protocol was registered in the PROSPERO database (CRD42021252428). 15 studies including 4,226 healthy adults (51% males) and reporting 3DE values of LAVi max, LAVi min and LA-EF were selected. LAVi max, LAVi min and LA-EF mean and reference values were equal to 25.18ml/m2 (95% CI 23.10, 27.26), 11.10ml/m2 (10.01, 12.18) and 55.94% (51.92, 59.96), respectively. No influential studies were identified. Pooled estimates per age group- and sex were also estimated. By meta-regression analyses, we identified variability in LA volumes and LA-EF depending on participants' age, ethnicity and number of heart cycles at 3D multi-beat acquisition. At individual patient data analysis conducted on 374 subjects, a software effect on LA-EF was shown. This systematic review and meta-analysis provides reference values of LAVi max, LAVi min and LA-EF assessed by 3DE in healthy adults, encouraging 3DE evaluation of the LA evaluation in daily practice.

A left ventricular phantom for 3D echocardiographic twist measurements.

Traditional two-dimensional (2D) ultrasound speckle tracking echocardiography (STE) studies have shown a wide range of twist values, also for normal hearts, which is due to the limitations of short-axis 2D ultrasound. The same limitations do not apply to three-dimensional (3D) ultrasound, and several studies have shown 3D ultrasound to be superior to 2D ultrasound, which is unreliable for measuring twist. The aim of this study was to develop a left ventricular twisting phantom and to evaluate the accuracy of 3D STE twist measurements using different acquisition methods and volume rates (VR). This phantom was not intended to simulate a heart, but to function as a medium for ultrasound deformation measurement. The phantom was made of polyvinyl alcohol (PVA) and casted using 3D printed molds. Twist was obtained by making the phantom consist of two PVA layers with different elastic properties in a spiral pattern. This gave increased apical rotation with increased stroke volume in a mock circulation. To test the accuracy of 3D STE twist, both single-beat, as well as two, four and six multi-beat acquisitions, were recorded and compared against twist from implanted sonomicrometry crystals. A custom-made software was developed to calculate twist from sonomicrometry. The phantom gave sonomicrometer twist values from 2.0° to 13.8° depending on the stroke volume. STE software tracked the phantom wall well at several combinations of temporal and spatial resolution. Agreement between the two twist methods was best for multi-beat acquisitions in the range of 14.4-30.4 volumes per second (VPS), while poorer for single-beat and higher multi-beat VRs. Smallest offset was obtained at six-beat multi-beat at 17.1 VPS and 30.4 VPS. The phantom proved to be a useful tool for simulating cardiac twist and gave different twist at different stroke volumes. Best agreement with the sonomicrometer reference method was obtained at good spatial resolution (high beam density) and a relatively low VR. 3D STE twist values showed better agreement with sonomicrometry for most multi-beat recordings compared with single-beat recordings.

1184 Left atrial volumes by 3-dimensional but not 2-dimensional echocardiography predict cardiac death and events in patients with heart failure with reduced ejection fraction

Abstract Background Patients with heart failure with reduced ejection fraction (HFrEF) are at high risk for mortality and morbidity. Left atrial volumes (LAVs), measured by 2-dimensional echocardiography (2DE), have been suggested as possible prognostic markers. However, LAVs measured by 2DE are prone to errors due to geometric assumptions and increased variability, whereas 3-dimensional echocardiography (3DE) has been proved to be a more accurate and reproducible method for volume assessment. Purpose To assess the comparative prognostic value of LAVs, measured by 2DE and 3DE, in patients with ischemic and non-ischemic HFrEF, on best clinical care. Methods 135 consecutive patients (59 ± 15 years, 91 males), diagnosed with HFrEF, in sinus rhythm, were assessed by 2DE and 3DE, including full-volume multi-beat acquisitions of the LA and left ventricle (LV). Maximal and minimal indexed LAVs were measured from the 2DE datasets using biplane area-length formula (2D_LAVmax and 2D_LAVmin); and from the 3DE datasets using a dedicated software package (3D_LAVmax and 3D_LAVmin). Patients were followed for 23 ± 14 months after the index event. Primary outcome was cardiac death (CD); secondary outcomes were: 1) HF hospitalization (HFH); 2) a composite cardiac events (CE) end-point, of cardiac death or hospitalization for heart failure, myocardial infarction, coronary revascularization, arrhythmias, or cardiac resynchronization therapy. Results 26 CD, 32 HFH, and 48 CE occurred during follow-up. 2DE and 3DE measurements are in the table. LAVs measured by 2DE did not correlate with outcome. However, 3D_LAVmax and 3D_LAVmin correlated with CD (r = 0.40 and r = 0.38) and CE (r = 0.30 and r = 0.29), all p &amp;lt; 0.05, but not with HFH. By multivariate linear regression analysis, only 3D_LAVmax and 3D_LAVmin were independent predictors for CD and CE, in patients with HFrEF (r²=0.30 and r²=0.32; p &amp;lt; 0.01). Conclusion In patients with HFrEF, LA volumes measured by 3DE, but not by 2DE, were independent predictors for cardiac death and events. However, even LA volumes by 3DE did not have predictive value for future HF rehospitalizations. Echo features for patients with HFrEF 3D end-diastolic LV volume (ml/m2) 101 ± 32 3D end-systolic LV volume (ml/m2) 71 ± 29 3D LV ejection fraction (%) 30 ± 8 2D_LAVmax (ml/m2) 52 ± 18 2D_LAVmin (ml/m&amp;sup2;) 31 ± 15 3D_LAVmax (ml/m2) 43 ± 18 3D_LAVmin (ml/m2) 29 ± 16

6066Equal significance of longitudinal and radial wall motion represents the normal right ventricular mechanical pattern: 3D echocardiographic study in 231 healthy volunteers

Abstract Three main mechanisms contribute to right ventricular (RV) pump function: (1) shortening of the longitudinal axis with traction of the tricuspid annulus towards the apex; (2) inward (radial) movement of the RV free wall, which is often referred as the “bellows effect”; and (3) bulging of the interventricular septum into the RV during the left ventricular contraction and stretching of the free wall over the septum (causing shortening in the anteroposterior direction). Despite the established clinical value of the functional changes among the aforementioned components, their relative importance remains to be quantified during physiological conditions. Accordingly, the aim of our study was to evaluate the relative contribution of the different RV motion directions to global RV function on both global and segmental level in a large set of healthy individuals. We have recruited 231 healthy volunteers (44% female, with a wide and balanced age range from 8 to 81 years) from two experienced centers performing transthoracic 3D echocardiography (3DE) on a routine basis. 3DE datasets focused on the RV were obtained using multi-beat acquisition. We determined RV volumes and subsequent ejection fraction (RVEF) by dedicated software. Using the ReVISION method, we have decomposed the motion of the RV to determine longitudinal (LEF), radial (REF) and anteroposterior ejection fraction (AEF). Their ratio to RVEF quantifies the relative contribution of the given component to global RV function. Moreover, regional subvolumes were also analyzed in a 15-segment model. Mean value of RVEF was significantly higher in female subjects compared to male subjects (60±7 vs. 56±7%, p&lt;0.001). The relative contributions of LEF and REF to RVEF were comparable, while the contribution of AEF was significantly lower (LEF/RVEF vs. REF/RVEF vs. AEF/RVEF: 0.48±0.08 vs. 0.49±0.07 vs. 0.39±0.11, p&lt;0.001) in the pooled population as well as in the genders separately. In line with higher RVEF found in women, female gender was associated with a higher longitudinal and radial contribution compared to males, however, AEF was similar (women vs. men; LEF/RVEF: 0.49±0.08 vs. 0.47±0.07, p&lt;0.05; REF/RVEF: 0.50±0.07 vs. 0.48±0.06, p&lt;0.01; AEF/RVEF: 0.38±0.12 vs. 0.40±0.10, p=NS). Interestingly, AEF/RVEF showed a significant deterioration with age (r=−0.354, p&lt;0.001), while age-dependency of the longitudinal and radial contributions were not observed concerning both genders. An age-related decrease could be demonstrated by the volume fractions of the 5 septal volumetric segments (r=−0.229, p&lt;0.001). Motion decomposition and the 15 segments In physiological conditions, the relative importance of longitudinal and radial wall motions is similar in determining global RV function. Aging accompanied by a decrease in anteroposterior shortening, which may point to a deteriorating systolic LV-RV interaction. Our results may facilitate further research concerning the alterations of RV mechanical pattern in various disease states.

Stepwise Protocols for Scoring of Mitral Valve using Three-Dimensional Transthoracic Echocardiography in Mitral Stenosis.

Aim:This study aims to propose protocols that enable scoring of mitral valve (MV) in mitral stenosis using the three-dimensional (3D) scoring system.Methods:A two-staged study was conducted. The first stage was designed to select the best 3D images of MV leaflets and chordae through analysis of 471 images. The second stage was designed to organize the best 3D images into protocols for complete scoring of MV. It included 35 consecutive patients; 23 had sinus rhythm (SR) and 12 had atrial fibrillation (AF). Both single- and multi-beat 3D acquisition from apical and parasternal windows were focused on MV leaflets and chordae using all 3D modalities (live, zoom, and full volume). To propose the protocols, 1563 images were analyzed.Results:In SR with good apical window, 2 protocols were recommended for complete scoring of leaflets and chordae (4 zoom 3D images [1 image for leaflets and 3 images for chordae] and 1 full-volume 3D image) using single- and multi-beat acquisition. In AF, the same 2 protocols using single-beat acquisition were recommended. From parasternal window, complete scoring of leaflets was obtained by 3 recommended protocols (single- or multi-beat zoom 3D images from parasternal short axis [PSAX], multibeat live 3D images from PSAX, and single- or multi-beat full-volume 3D images from parasternal long axis) in SR and 1 protocol in AF (single-beat zoom 3D images from PSAX). Scoring of chordae was incomplete in all patients by all 3D modalities.Conclusions:The proposed 3D-transthoracic echocardiography protocols suit all patients regardless of echo window and heart rhythm and enabled complete MV scoring.

The Role of Automated 3D Echocardiography for Left Ventricular Ejection Fraction Assessment.

Ejection fraction is one of the most powerful determinants of prognosis and is a crucial parameter for the determination of cardiovascular therapies in conditions such as heart failure, valvular conditions and ischaemic heart disease. Among echocardiographic methods, 3D echocardiography has been attributed as the preferred one for its assessment, given an increased accuracy and reproducibility. Full-volume multi-beat acquisitions are prone to stitching artefacts due to arrhythmias and require prolonged breath holds. Single-beat acquisitions exhibit a lower temporal resolution, but address the limitations of multi-beat acquisitions. If not fully automated, 3D echocardiography remains time-consuming and resource-intensive, with suboptimal observer variability, preventing its implementation in routine practice. Further developments in hardware and software, including fully automated knowledge-based algorithms for left ventricular quantification, may bring 3D echocardiography to a definite turning point.

Feasibility of One-Beat Real-Time Full-Volume Three-Dimensional Echocardiography for Assessing Left Ventricular Volumes and Deformation Parameters

Real-time three-dimensional echocardiographic (3DE) imaging usually requires multibeat acquisition to maintain high temporal and spatial resolution for full-volume data sets. However, this procedure generates stitch artifacts in patients with irregular heartbeats; thus, one-beat acquisition might be useful. The aim of this study was to compare the efficacy of using new-generation one-beat full-volume acquisition for measuring left ventricular (LV) mechanical parameters with that of four-beat acquisition. In protocol 1, 34 patients who had undergone both cardiac magnetic resonance and 3DE imaging on the same day were prospectively enrolled. In protocol 2, 115 patients in sinus rhythm who had undergone 3DE examinations were retrospectively enrolled. LV volume, ejection faction, and global strain were measured using one-beat and four-beat 3DE data sets. In protocol 3, 26 patients with atrial fibrillation who had acquisition of consecutive one-beat full-volume data sets were retrospectively enrolled, and it was determined whether the LV parameters in the index beat were correlated with corresponding average values obtained from multiple one-beat acquisitions. In protocol 1, the correlations between LV volumes and LV ejection fraction between cardiac magnetic resonance and 3DE imaging with one-beat acquisition were excellent (r=0.91-0.93). In protocol 2, correlations were also excellent (r=0.94-0.99), and there were no significant differences in volume rate, LV volumes, LV ejection fraction, and global strain parameters between one-beat and four-beat acquisition data sets. In protocol 3, correlations were excellent (r=0.94-0.99) between LV parameters from the index beat and corresponding average values. Three-dimensional echocardiographic full-volume data sets with one-beat acquisition not only maintained volume rate but also provided LV mechanical parameter values similar to those obtained using multibeat acquisition. Using one-beat acquisition for patients with atrial fibrillation expands its clinical applicability.

Diferencias en la infraestimación de los volúmenes del ventrículo izquierdo entre 2 sistemas de ecocardiografía 3D. Comparación con resonancia magnética

Introduction3-D echocardiography (3DE) is superior to the 2-D technique in assessing left ventricular (LV) volumes and ejection fraction (EF). This study compares two 3DE systems with cardiac magnetic resonance imaging (cMRI): single-beat 3DE with automated endocardiac border detection (Siemens SC2000;A) and 3DE with multi-beat acquisition and semi-automated endocardiac borders detection (Philips iE33;B). MethodsA 3DE with single-beat acquisition and automated border detection (A) and 3DE with multi-beat acquisition and semi-automated border detection (B) was performed on 22patients referred for a study using cMRI. ResultsThe mean volumes and EF measured by cMRI were: DTV: 211.07±85.4mL; STV: 119.2±89.25mL; EF: 48.67±20.07%. The correlation between cMRI and the two 3DE systems was excellent for the DTV (rhoA 0.912; rhoB 0.907; P<.0001), STV (rhoA 0.877; rhoB 0.945; P<.0001) and EF (rhoA 0.974; rhoB 0.951; P<.0001). The Bland-Altman analysis showed an underestimation of the LV volumes with both 3DE systems, with the difference being lower in systemA than in systemB (–40±50.2 vs –82.2±40.9mL, respectively for DTV; –16±44.4 vs –43±43.5mL, respectively for STV; P=.001). There were no differences in the measurement of EF between the 3imaging techniques. Conclusion3DE underestimates LV volumes. In our series, this underestimate was lower in the system with single-beat acquisition and automated border detection.

Abstract 9449: Feasibility and Accuracy of High Resolution 4D Echocardiography for Evaluation of Left Ventricular Mass and Stroke Volume: An in vitro Phantom Study

Background: This study was designed to determine the accuracy and feasibility of a new 4D echo-based semi-automated quantification of left ventricular (LV) mass (LVM) and stroke volume (SV) in an in vitro phantom model. Methods: Ten freshly harvested adult pig and sheep hearts (147-326 grams) were passively driven using a pulsatile pump to simulate normal cardiac motion. Each heart was pumped at 3 stroke rates (SR) (40, 65, and 85 strokes/min) and 3 SVs (30, 50, and 70 ml at each SR). Full-volume 4D cine loops were collected with a 3V Matrix transducer interfaced with a GE Vivid E9 ultrasound system at a maximized frame rate (≥25 FPS) using multi-beat acquisition. Images were analyzed offline using EchoPAC PC for semi-automated quantification of SV and LVM and compared to displacement values. Results: No significant differences were detected between the values of either SV or LVM at different stroke rates (P=0.99). Data showed excellent linear correlation between 4D echo-derived SV and LVM, and displacement data (SV: R 2 =0.96, p&lt;0.001; LVM: R 2 =0.99, p&lt;0.001). Bland-Altman analyses revealed 98% and 99% of points within a 95% CI for SV and LVM respectively. Interobserver variability was shown to be excellent (SV: R 2 =0.92, p&lt;0.001; LVM: R 2 =0.99, p&lt;0.001). Conclusions: 4D echo-based quantification may be an accurate and feasible method for determination of LV mass and stoke volume and a physiologically relevant range of stroke volumes and stroke rates.

Accuracy of Real-Time Single- and Multi-Beat 3-D Speckle Tracking Echocardiography In Vitro

With little data published on the accuracy of cardiac 3-D strain measurements, we investigated the agreement between 3-D echocardiography and sonomicrometry in an in vitro model with a polyvinyl alcohol phantom. A cardiac scanner with a 3-D probe was used to acquire recordings at 15 different stroke volumes at a heart rate of 60 beats/min, and eight different stroke volumes at a heart rate of 120 beats/min. Sonomicrometry was used as a reference, monitoring longitudinal, circumferential and radial lengths. Both single- and multi-beat acquisitions were recorded. Strain values were compared with sonomicrometer strain using linear correlation coefficients and Bland–Altman analysis. Multi-beat acquisition showed good agreement, whereas real-time images showed less agreement. The best correlation was obtained for a heart rate 60 of beats/min at a volume rate 36.6 volumes/s.

Oral Abstract Sessions: Young Investigator Award session * Thursday 8 December 2011, 12:45-13:45 * Location: Pecs

Oral Abstract Sessions: Young Investigator Award session * Thursday 8 December 2011, 12:45-13:45 * Location: Pecs

Single-Beat Versus Multibeat Real-Time 3D Echocardiography for Assessing Left Ventricular Volumes and Ejection Fraction

Background— Real-time 3-dimensional echocardiography (RT3DE) is superior to 2D echocardiography in assessing left ventricular (LV) volumes and ejection fraction (EF), but its feasibility is limited by multibeat acquisition, which requires an optimal breath-hold and a regular heart rhythm. We sought to evaluate the accuracy and feasibility of single- and 2-beat RT3DE for LV volume and EF assessment. Methods and Results— Sixty-six consecutive patients referred for cardiac magnetic resonance (CMR) underwent RT3DE and CMR on the same day. Of the 50 patients (age, 59±18 years; 68%men; 42% coronary artery disease; LVEF=49±14%; limits, 14% to 76%) with an adequate RT3DE image quality, accuracy for LV volumes and EF measurements of single- and 2-beat modalities were compared with the conventional 4-beat acquisition and CMR. Correlations with CMR for LV end-diastolic volume (161±59 mL, r =0.93 to 0.94) and end-systolic volume (86±56 mL, r =0.93 to 0.96) were excellent regardless of the number of cardiac cycles used. However, because of the low temporal resolution (7±2 volumes per second), single-beat underestimated LVEF (bias, −5±8%) with greater bias than 2-beat (bias, 1±6%, P &lt;0.001) and 4-beat (bias, 3±7%, P &lt;0.001) modalities. Interestingly, 2-beat provided accuracy similar to 4-beat for end-diastolic volume (bias, −17±21 mL versus −15±23 mL), end-systolic volume (bias, −9±16 mL versus −12±17 mL), and LVEF (bias, 1±6% versus 3±7%) measurements, but fewer stitching artifacts were observed with 2- than 4-beat modalities (3% versus 30%). Conclusions— Compared with conventional multibeat acquisitions, 2-beat modality provides similar accuracy in LV volume and EF measurements and should be preferred due to fewer stitching artifacts. In contrast, the temporal resolution of single-beat modality appears insufficient to provide an accurate estimation of LVEF.